Rapid HIV Testing: not so fast!

RapidTesting

Today is a great day in the fight against HIV/AIDS.  Rapid HIV testing has been approved for use in Australia by the Therapeutic Goods Administration.

Rapid testing was originally developed for use in low-income countries (like Africa) as a tool to help address the dreadfully high prevalence of HIV in the population.  There are three methods for rapid testing: one uses urine, another uses some saliva, while the Alere Determine™ HIV Combo test (the one approved today) uses a prick of blood, similar to a diabetic blood sugar test to provide HIV results in about 20 to 30 minutes.  The TGA has put together a more comprehensive Q&A about rapid testing here.

Though I welcome rapid testing, we need to be realistic. Frankly I fear that a lot of the understandable exuberance at this announcement has moved away from reality.

Will rapid testing lead to more testing? According to Dr Tim Read of  the Melbourne Sexual Health Centre, The School of Population Health University of Melbourne and Victorian Infection Disease Service, Royal Melbourne Hospital (Dr Read gets around) there is no evidence to support the intuitive belief that rapid testing will lead to more testing.  In fact, one African study found that HIV testing rates went down.  Just because we can do something, it doesn’t necessary follow that people do it.  Dr Read’s Melbourne trial did, however, show that rapid testing was useful in the gay community.

CSIRO has published research showing that about 40% of gay men don’t bother getting tested for HIV because they need to have a second visit to get results.  Mind you, this CSIRO study conclude most gays don’t get tested because they don’t believe they had done anything risky, or they hadn’t shown any symptoms of STIs.

One downside of rapid testing is that it produces more false positives, with almost no opportunity for pre-result counselling.  When presented with a positive HIV test a lot of people experience deep shock, depression, and an understandably dark time in their lives.  Any positive result from rapid testing needs to be followed up with a lab-test, however a lot of people are going to experience a lot of trauma for no good reason.

Some guys will have the opposite reaction: how long will it be until guys get a false positive and go “oh, well, I’m positive, damage done, time to climb into the nearest sling and take all comers”? (so to speak).

Before you leave angry comments telling me that no one would do something that negligent, let me remind you that HIV transmission went up by 8% across Australia last year.  Our proclivity for bareback sex is precisely how we got into this mess to begin with – imagine giving someone the misguided notion that ‘the damage is done’, or diluting safe-sex messages under those circumstances?

Surely though more people knowing their HIV status will lead to higher levels of disclosure, right?  Well, no: in Melbourne only 17% of men disclose their HIV status before having unprotected sex.  Some argue this is because HIV stigma is so strong in this state.  One quick look at sites like BreedingZone.com, bbrt, or the Bareback Brotherhood suggests that “stealthing” is also often a deliberate policy, a policy that is more common than one might imagine.

We even hear of criminal cases alleging recklessly negligent and sometimes deliberate attempts at transmission of HIV like that of Godfrey Zaburoni, 32Adam Randall, 36, or Rhys Martin (20) or the conviction of a straight 52 year old man in Melbourne.

Even if you sexual partners are clear of HIV, there are threats like syphilis, gonorrhoea, HPV (which can lead to anal cancer – yes ANAL CANCER) and Hep-C (which makes HIV look like a bad cold).

In short, safe, unprotected sex is a contradiction in terms.  You basically have to boil people before you sleep with them.  So while I welcome rapid testing’s approval, I have to be honest: it doesn’t make me feel safer.

For the love of Gaga – if you’re a top cover your stump before you hump, if you’re a bottom practice a policy of no glove, no love and if you’re versatile remember if it is not on, it’s not on.

Should you happen to be straight, well honestly I have no idea how you guys shag but please wrap the pickle before you get into the slap-n-tickle.

Of course I welcome a cheaper and easier way to get tested for HIV.  Just remember a negative HIV test result isn’t a license to have bareback sex: it’s a reminder that no one gets sick if you wrap that dick.

 

Update (12:02pm, 17 Dec):

Rob Lake, Executive Director of Australian Federation of AIDS Organisations has issued a press release welcoming rapid HIV testing.  Mr Lake said:

“Rapid HIV testing will help make HIV testing easier, increase the level of testing, and enable earlier diagnosis, so it’s very welcome news.”

 

“The approval of a rapid HIV test is a significant step towards fulfilling the actions outlined in the Melbourne Declaration and achieving the reduction in transmissions”, said Lake.

The Melbourne Declaration (www.melbournedeclaration.com) called for the approval of rapid HIV testing in Australia as one of the major actions to help achieve the target of a 50% reduction in sexual transmission of HIV by 2015.

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About the author

James Newburrie is a cyber-security specialist, the man who organised a marriage equality demo outside Mt Isa MP Bob Katters office, and runs the Facebook Equal Marriage page 32001names. Never without his unrelenting sense of logic or his trusty iPad he tweets as @Difficultnerd